Disease Sparks Chemical Attack Fear

[Jai Dee]

Disease sparks chemical attack fear

International health officials descend on Nan after 147 stricken after merit-making feast

A serious disease outbreak in the northern province of Nan yesterday had Army weapons specialists and US disease investigators on full alert.

Almost 150 people in the province have been stricken with botulism, a rare yet lethal bacterial disease that could potentially be used as a biological weapon.

Health authorities have sought international assistance treating the patients.

Military biological-weapons experts have been flown into Nan, as have World Health Organisation disease specialists, said Thai Disease Control Department chief Thawat Suntharacharn.

Since March 4, 143 villagers in Nan's Ban Luang district have been diagnosed as suffering from botulism, a disease caused by toxins produced by several members of a group of bacteria known as Clostridium botulinum.

All of the patients reported having eaten dishes containing preserved bamboo shoots from the same batch at a merit-making feast in their village last week. Shortly after eating the shoots they began to suffer similar symptoms, including vomiting, diarrhoea, difficulty swallowing, dry mouths and muscle weakness, Nan chief health officer Dr Pisit Sriprasert said on Sunday. Of the 143, 33 are currently breathing with the aid of respirators, he said.

"This bacterium is among three strains that can be used as a biological warfare agent - the others are anthrax and smallpox," said Thawat. Fears of a biological attack arose because of the number of people falling ill at one time.

Thawat said there were just a few cases of botulism reported each year in Thailand, and that was why there were no stockpiles of anti-toxin serums used to treat the disease.

Just 20 doses of the anti-toxin serum arrived on Sunday from the UK, but another 10 doses from Canada and 50 from the US arrived yesterday, he said.

And while that amount of serum should suffice to initially treat the patients, Thawat said it was vital more was procured for patients that remained in a critical condition. Thawat said the bill to treat the patients could top Bt10.5 million.

Officials said that of the 70 cans of bamboo shoots in the batch thought likely to have caused the outbreak, 68 had been sold earlier. The contents of just two of the tins likely infected the 143 patients at the merit-making feast.

Source: The Nation - Tue, March 21, 2006

[Jai Dee]

Specialists on full alert following outbreak of bacterial which could be use as weapon

A serious disease outbreak in the northern province of Nan had Army weapons specialists and US disease investigators on full alert Monday.

Almost 150 people in the province have been stricken with botulism, a rare yet lethal bacterial disease that could potentially be used as a biological weapon.

Health authorities have sought international assistance treating the patients.

US military biological weapons experts have been flown into Nan, as have World Health Organisation disease specialists, said Thai Disease Control Department chief Thawat Suntharacharn.

Since March 4, 143 villagers in Nan's Ban Luang district have been diagnosed as suffering from botulism, a disease caused by toxins produced by several members of a group of bacteria known as Clostridium botulinum.

All of the patients reported having eaten dishes containing preserved bamboo shoots from the same batch at a merit-making feast in their village last week. Shortly after eating the shoots they began to suffer similar symptoms, including vomiting, diarrhoea, difficulty swallowing, dry mouths and muscle weakness, Nan chief health officer Dr Pisit Sriprasert said on Sunday. Of the 147, 33 are currently breathing with the aid of respirators, he said.

"This bacterium is among three strains that can be used as a biological warfare agent - the others are anthrax and smallpox," said Thawat.

Fears of a biological attack arose because of the number of people falling ill at one time.

Source: The Nation - Tue, March 21, 2006

[Jai Dee]

Foreign health experts look into outbreak of botulism

The US Centers for Disease Control and Prevention (CDC) has dispatched experts to investigate food poisoning in Nan province after finding the bacteria causing the outbreak is the same strain used to make biological weapons, the Disease Control Department said yesterday.

Almost 170 villagers from Ban Luang district were admitted to the provincial hospital last week after eating tinned bamboo shoots and developing botulism, a form of food poisoning caused by the clostridium botulinum bacteria.

Seventy-seven patients are being treated in the hospital, and 39 of them are in a coma.

The US health experts were closely monitoring the patients' conditions, Disease Control Department chief Thawat Sundracharn said at a press conference yesterday.

"The CDC is eager to study the ... outbreak in order to strengthen the US preparedness for a biological weapons attack," said Dr Thawat.

Clostridium botulinum bacteria, anthrax and smallpox were the three major components of biological weapons at the moment, he added.

The US infectious disease experts had brought with them 50 doses of anti-toxin serum to try to cure the patients. Britain and Canada had also donated 30 doses of the serum to Nan hospital.

However, he said, the ministry would acquire additional serum from Japan to prepare for any fresh outbreak.

Thailand did not stockpile the serum because usually the number of cases per year was small, Dr Thawat said, adding that the large number in the Nan outbreak was unprecedented.

Dr Thawat said people could develop symptoms of botulism within 12-36 hours of contact with the bacteria. Symptoms include blurred vision, a dry mouth, nausea, vomiting and muscle weakness leading to limb paralysis. In serious cases, the patient would suffer respiratory system failure, a major cause of death among patients with botulism.

A person could contact the disease through a wound or by eating contaminated food.

The department had so far destroyed all 70 locally-produced tins of bamboo shoots to prevent the disease spreading further, said Dr Thawat. A team of medics investigating the disease outbreak suspected that the villagers' unhygienic production of tinned bamboo shoots was the cause of the food poisoning.

Source: Bangkok Post - 21 Mar 2006

[astral]

Nan chief health officer Dr Pisit Sriprasert said on Sunday. Of the 143, 33 are currently breathing with the aid of respirators, he said.

Lucky they have so many respirators available.

Here in Bombay (Mumbai) the recent Bird Flu worries have raised the question of how few

respirators are available for emergencies in a large city of millions

[Jai Dee]

Cabinet approves the budget of 33 million baht to assist the people who experienced food poisoning

The Cabinet meeting today has approved the budget of 33 million baht for the Public Health Ministry to assist patients who experienced food poisoning after consuming canned bamboo shoots.

Public Health Minister Phinij Jarusombat (พินิจ จารุสมบัติ) revealed that the Cabinet has approved 33 million baht to help patients in Nan (น่าน) and nearby provinces. The patients received botulinum toxin after consuming canned bamboo shoots.

He said the budget will be used for purchasing respirators and serums from Japan to cure the patients. However, the recent report indicated that the incident is not worrying as the patients have significantly recovered.

He has instructed the Public Health Office in the northern region to publicize and educate people about consuming canned food. He said such incident has no impact on the export sector.

Minister Pinij added that Prime Minister Thaksin Shinawatra has assigned the Public Health Ministry during the Cabinet meeting to speed up the publicizing and provide information to people over consuming bamboo shoots since there are lots of misunderstandings among the general public.

Source: Thai National News Bureau Public Relations Department - 21 March 2006

[zzap]

"...provide information to people over consuming bamboo shoots since there are lots of misunderstandings among the general public. "

Does anyone know what is the deal with bamboo shoots?

This canned batch was just a bad lot (lack of hygiene?), or are there general precautions one should be aware of?

[sriracha john]

From WHO:

There are seven recognized types of botulism. Four of these (types A, B, E and rarely F) cause human botulism. Types C, D and E cause illness in mammals, birds and fish.

Ingestion of the toxin present in improperly prepared food is dangerous and may be fatal. Botulism is mainly a foodborne intoxication but it can also be transmitted through wound infections or intestinal infection in infants.

The symptoms are not caused by the organism itself, but by the toxin that the bacterium releases.

Incidence of botulism is low, but the mortality rate is high if treatment is not immediate and proper.

I hope they get the remaining quantity of needed meds QUICKLY.

The disease can be fatal in 5 to 10% of cases.

The disease can progress to weakness in the neck and arms, after which the respiratory muscles and muscles of the lower body are affected. The paralysis may make breathing difficult. There is no fever and no loss of consciousness. Similar symptoms usually appear in individuals who shared the same food. Most cases recover, if given proper and immediate treatment, including prompt diagnosis, early administration of antitoxin and intensive respiratory care.

key word: IF

Clostridium botulinum is an "anaerobic bacterium", which means it can only grow in the absence of oxygen.

Therefore, the growth of the bacteria and the formation of toxin tend to occur in products with low oxygen content and the right combination of storage temperature and preservative parameters. This happens most often in lightly preserved foods such as fermented, salted or smoked fish and meat products and in inadequately processed home canned or home bottled low acid foods such as vegetables.

The toxin is destroyed by normal cooking processes (heating at >85C for five minutes or boiling for a few minutes).

Prevention of botulism is based on good food preparation (particularly preservation) practices and hygiene. Botulism may be prevented by inactivation of the bacterial spores in heat-sterilized, canned products or by inhibiting growth in all other products.

Refrigeration temperatures combined with salt content and/or acidic conditions will prevent the growth or formation of toxin.

Treatment:

Antitoxin administration is indicated as soon as possible after clinical diagnosis has been made. Severe botulism cases require supportive treatment, especially mechanical ventilation, which may be required for weeks or months. Antibiotics are not required (except in the case of wound botulism). There is a vaccine against botulism, but it is used very rarely as its effectiveness is not fully evaluated and it has side effects.

[jdinasia]

and we use this stuff in Plastic surgery? (well not exactly but you know what I mean ... BoTox= Botulism Toxin

[Jai Dee]

A budget of 33 million baht has been allocated to the Public Health Ministry to help patients who received toxins after eating contaminated canned bamboo shoots

The cabinet has approved a budget of 33 million baht for the Public Health Ministry to help patients who received toxins after eating contaminated canned bamboo shoots.

Public Health Minister Pinij Jarusombat (พินิจ จารุสมบัติ) revealed that the cabinet meeting has approved a budget of 33 million baht for the ministry to help treat patients receiving botulinum after eating contaminated canned bamboo shoots in Nan. He said that the budget will be used to purchase serums from Japan as well as respiratory equipment. He said that the patients’ conditions are improving; however, he said that the Public Health officers of the Northern provinces have been reiterated to educate the people on this issue. He insisted that the case will not affect exports, as the bamboo shoots production was family industry.

The Public Health Minister added that the ministry will formulate plans to educate the people on consuming bamboo shoots as the people now have a wrong idea on the issue.

Secretary-general of the Food and Drug Administration (FDA) Pakdi Potisiri (ภักดี โพธิศิริ) advised that the people should boil bamboo shoots at the temperature of 100 degrees Celsius for at least 30 minutes and pour the water out. He said that doing so will help prevent dangers from the botulinum which can cause disease.

He said that in the future, the agency will issue regulations requiring that the production place must pass the GMP standards. He said that the FDA officials will inspect production process as well as giving knowledge to the people.

Source: Thai National News Bureau Public Relations Department - 22 March 2006

[Toni]

"Disease Sparks Chemical Attack Fear, Specialists on Full Alert

A serious disease outbreak in the northern province of Nan yesterday had Army weapons specialists and US disease investigators on full alert.

Almost 150 people in the province have been stricken with botulism, a rare yet lethal bacterial disease that could potentially be used as a biological weapon.

Military biological-weapons experts have been flown into Nan,"

One has to take these outbreaks serious of course, but isn't it this a bit too much fuz?

First of all why such an attack in a remote Thai area?

As I read a bit further there could be badly prepared food involved! I think it is better to think before spreading these headlines and frighten half of the country!

Botulism is not rare in Europe either and every year when it is a hot summer a small outbreak happens caused by public water getting bad caused by high temperatures and very low oxigin-levels. These are generated by the faeces of the water birds and certain algea.

Furthermore knowing when there is a Thai happening lots of people are joining and eating so the amount of victims can be hugh.

[Toni]

"...provide information to people over consuming bamboo shoots since there are lots of misunderstandings among the general public. "

Does anyone know what is the deal with bamboo shoots?

This canned batch was just a bad lot (lack of hygiene?), or are there general precautions one should be aware of?

this is also my question. only being carefull with bamboo shoots?

All is very confusing and the better start correcting the fuzz around the biological/chemical alarts!

[george]

Update:

Japan to airlift anti-toxin serum to Thailand

BANGKOK: -- Japan has agreed to Thailand's request to dispatch anti-toxin serum to help treat more than one hundred villagers in the northern Thai province of Nan who contracted botulism from contaminated processed bamboo shoots this week.

Japan would also send experts to study what is believed to be the worst incident of botulism on record worldwide, according to a senior official of the Ministry of Public Health.

Thawat Suntrajarn, director-general of the Disease Control Department, said on Wednesday that the number of patients who are still under medical supervision in hospital has been reduced to 118. Some critically-ill patients are to be airlifted to Bangkok hospitals on Thursday.

Some 168 villagers contracted Clostridium botulism -- a rare neuromuscular disease that is often fatal -- after eating bamboo shoots that had been stored in aluminium cans. It is the largest reported incident of botulism ever in Thailand.

He said Thailand had asked Japan for an additional 70 doses of anti-toxin serum after some 70 doses were received earlier from Britain, Canada and the United States were used already. Only 10 doses remaining on hand to treat critically-ill patients.

It is expected that the additional doses from Japan will arrive on Thursday.

Among those who have been hospitalised, 42 patients are still on respirators, while 50 others have been released from hospital.

Dr. Thawat said the Cabinet on Tuesday approved a special budget allocation of Bt33 million (US$825,000) to treat the victims

Meanwhile, Anutin Charnvirakul, deputy minister of public health said the ministry has contracted with the Royal Thai Airforce to airlift some 40 gravely-ill patients to Bangkok hospitals on Thursday.

--TNA 2006-03-22

[kyselak]

Patients to be treated in Bangkok for food poisoning by

strain used in biological weapons

BANGKOK, Thailand (AP) _ Health workers will transport

about 40 patients from the country's north to Bangkok to

receive medical treatment for food poisoning caused by a

bacteria used in the production of biological weapons, an

official said Wednesday. Last week, 143 people suffered

stomach pains, vomiting and muscle weakness after eating

fermented bamboo shoots at a temple fair in the northern

Thai province of Nan, and 39 remain in critical condition.

The patients will be flown Thursday to Bangkok in an air

force C-130 airplane, said Deputy Public Health Minister

Anuthin Charnveerakul. «Due to the lack of standard

medical equipment in Nan, we will bring about 40 patients

who are still in critical condition to Bangkok,» Anuthin

said.

221153 mar 06GMT

[Kerryd]

Little wonder there is confusion.

Disease sparks chemical attack fear

Officials said that of the 70 cans of bamboo shoots in the batch thought likely to have caused the outbreak, 68 had been sold earlier. The contents of just two of the tins likely infected the 143 patients at the merit-making feast.

Source: The Nation - Tue, March 21, 2006

Foreign health experts look into outbreak of botulism

The department had so far destroyed all 70 locally-produced tins of bamboo shoots to prevent the disease spreading further, said Dr Thawat.

Source: Bangkok Post - 21 Mar 2006

They were able to acquire all 68 of the 70 cans that had been sold earlier so quickly ? And destroyed them without testing them ?

Strange.

Hope the villagers get better quickly. Good to see certain countries have been very prompt with shipping serum to Thailand. Doesn't appear that any one country maintains a large supply though.

Not totally unexpected though, as some serums/vaccines have a short shelf life.

Edited March 23, 2006 by Kerryd

[Jai Dee]

Public Health Minister visited patients suffering from botulinum toxins who have been transferred to BKK.

Public Health Minister Phinij Jarusombat (พินิจ จารุสมบัติ) gave moral support for patients suffering from eating canned bamboo shoots who have been transferred to hospitals in Bangkok, while insisting that they will all recover soon.

Mr. Phinij and deputy Public Health Minister Anutin Charnvirakul (อนุทิน ชาญวีรกูล) as well as other senior officials came to give moral support for 17 patients receiving toxins from eating canned bamboo shoots in Nan province who have been transferred to Bangkok yesterday.

Mr. Phinij said that he has talked with the medical team and was told that all 17 patients have serious conditions, as they cannot breathe on their own. He said that he has reiterated to the medical team, urging a special care for the patients, adding that he expected that it may take some time before they recover. He said that the doctors must also be careful about infection.

Mr. Phinij said that this case prompted the medical field to study clostridium botulinum, which the Department of Disease Control has indicated as material for biological weapon production. As for the budgets to treat the patients in the long run, Mr. Phinij said that the ministry will use the 33 million baht budget approved by the cabinet.

The 17 patients comprising of 12 females, 4 males, and 1 child, have been distributed to Chulalongkorn University Hospital, Vajira (วชิระ) hospital, the Bhumibol (ภูมิพล) hospital, the Rajvidhi (ราชวิถี) hospital, the Ramathibodi (รามาธิบดี) hospital, and the Phra Mongkutklao (พระมงกุฎเกล้า) hospital.

Source: Thai National News Bureau Public Relations Department - 24 March 2006

[Losangels]

Has anyone investigated the source of the canned bamboo shoot? Where it was produced, how it was produced and whether proper food safety manufacturing steps were followed. I believe its the job of the Food and Health department.

[sriracha john]

Public Health Minister Phinij Jarusombat said health officials had been instructed to closely monitor the situation and make a study of the case and come up with a plan to control any future outbreak.

''The ministry will also work jointly with scientists and military officers to study the linkage between the bacteria and biological weapons production and the development of biochemical weapons,'' he said.

Just 0.5cc of bacteria could kill more than 500,000 people.

''It seems that it is easy to make biological weapons from such lethal bacteria, which can simply be found in food.

''The government must put up its guard against the spread of the disease,'' he said.

- BP

[zzap]

I asked some people in the village (I am in Nan at the moment), and the way they learned to cook it, is as the department suggested - boil it for half an hour and throw away the water.

[English Noodles]

Treatment:

Antitoxin administration is indicated as soon as possible after clinical diagnosis has been made.

These guys are getting involved in everything

SJ I have my sense of humour back today

Edited March 24, 2006 by English Noodles

[sriracha john]

Treatment:

Antitoxin administration is indicated as soon as possible after clinical diagnosis has been made.

These guys are getting involved in everything

SJ I have my sense of humour back today

YEAH!! glad to have both you back together again!...

[ausiekid]

Why not airlift some antitaxsin serum is well when they are at it.

[Jai Dee]

5 patients suffering symptoms from Clostridium Botulinum have been discharged from hospital

The Public Health Ministry revealed that 5 of the patients suffering symptoms from Clostridium Botulinum can return home. Meanwhile, 11 other patients still need respirators, but their conditions have improved.

Acting permanent secretary of the Public Health Ministry Dr. Prat Boonyawongwiroj (ปราชญ์ บุญยวงศ์วิโรจน์) said that 5 out of 64 patients suffering from Clostridium Botulinum and receiving treatment at Nan (น่าน) Hospital have been allowed to return home yesterday. He added that 11 patients still remain in the ICU units and need respirators as they cannot breathe on their own. He said that they remain under close monitoring by medical team. Dr. Prat said that most of the patients have shown improvements in conditions, while there are no new patients in the village where the case occurred.

Meanwhile, Dr. Pisit Sriprasert (พิศิษฐ์ ศรีประเสริฐ), based in Nan (น่าน) province, said that today, the Public Health office will send mobile medical units to give free services for villagers and follow up on conditions of the patients who have returned home until all of them recover from the conditions. He added that the Office has produced a radio program to educate and answer questions by villagers about the disease.

He added that the people can also call Nan Hospital at 0-5477-1620, Ban Luang (บ้านหลวง) hospital at 0-5476-1060, or provincial public health officer at 0-1883-7601.

Source: Thai National News Bureau Public Relations Department - 27 March 2006

[Jai Dee]

12 more botulism patients discharged from hospital

Nan Hospital discharged 12 more botulism patients on Tuesday, reducing the number of people still hospitalised with the rare and potentially fatal illness to 44.

Of those 44, seven remain in intensive care.

"All of the inpatients are recovering satisfactorily," said Public Health Ministry acting permanent secretary Dr Prat Boonyawongvirot.

On March 14, 163 people were hospitalised with botulism after eating bamboo shoots contaminated with clostridium botulinum toxin at a meritmaking ceremony.

Clostridium botulinum is so dangerous and volatile it could potentially be used as a biological weapon.

Nan public health chief Dr Pisit Sriprasert said academics from the Medical Sciences Department and the Disease Control Department had collected samples of the preserved bamboo shoots yesterday to study how the clostridium botulinum had developed.

"Our research findings will help prevent another outbreak of this disease," he said.

The Medical Sciences Department is currently developing a testkit to detect clostridium botulinum.

Source: The Nation - March 28, 2006

[Jai Dee]

BOTULISM UNDER CONTROL

All patients to be home in a month

Public Health Ministry gives all-clear to 34 still in hospital; WHO praises Thailand's handling of the outbreak

All of the patients who contracted botulism from contaminated processed bamboo shoots are now safe and will be allowed home within the month, a senior official at the Public Health Ministry said yesterday, adding that the World Health Organisation (WHO) has praised Thailand's successful treatment of the mass poisoning.

Acting permanent secretary for public health Dr Prat Boonyawongwirot told a press conference yesterday that just 34 botulism patients remain in hospital, with 23 cases still dependent on respiratory aids. However, their conditions show distinct improvement and they should be released in 10 to 20 days, Prat said.

About 137 people in Nan's Ban Luang district were hospitalised with botulism after eating bamboo shoots contaminated with clostridium botulinum toxin at a merit-making ceremony on March 14.

Prat said the incident represented the world's largest mass botulism poisoning and Thailand's success in treating the patients has been praised by the WHO, with a number of other countries also sending experts to study preventative methods in order to avoid similar cases.

Disease Control Department director-general Thawat Suntrajarn thanked all parties, from both overseas and inside the country, who collaborated on the project which lead to the swift delivery of botulism antitoxin serum.

"The antitoxin is the key and patients must receive it within 72 hours to minimise the risk of complications," he said, adding that Thailand had used 88 of the 103 doses of antitoxin donated, and the rest would be kept at Nan Hospital for emergencies.

Botulism patient Wanida Porjai, who was discharged from Ratchavithi Hospital, thanked her doctors, the Public Health Ministry and related agencies for curing her.

"I couldn't move, couldn't speak for days. I thought I'd die, but everyone helped with my hospitalisation, and ultimately gave me a new life," she said.

Source: Bangkok Post - 6 April 2006